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Healthcare’s Frequent Flyers don’t earn miles, they add cost.

Posted Dec 23 2008 9:14pm

High risk behaviors and social irresponsibility typically invokes ill fated consequences for those that do not first think about their actions. For those of us in healthcare we see this cause and effect drama unfold all the time, but in the summer when the days are longer and school is out of session there is a heightened degree of “badness” that befalls those individuals that invite “Murphy” to come and visit them. The intoxicated individuals and obtunded persons from illicit drug use that pepper the evening hours of the nation’s emergency departments are huge consumers of finite resources both consumable and otherwise. Many of these individuals are deemed “frequent flyers” in the medical community because of their repetitive and numerous visits to the local emergency department.

Patients that are afflicted with mental illnesses are notoriously known for multiple visits to the emergency departments for the same presenting problems. Patients requesting detox from alcohol and drug use are daily occurrences. Many of these patients are uninsured or under insured. Many are disruptive and loud. Several of these patients must be physically restrained and chemically sedated during their emergency department stay as they become a danger to hospital staff and other patients. Many other patients become understandably horrified and truly scared at the actions of these out of control patients.

The healthcare system typically has a very poor time mitigating these medical cases in terms of any long term plan. Short term interventions are the hallmark are taking care of these patients. Sometimes these patients are discharged from the emergency department and come back in less than an hour by rescue. Valuable bed spaces in an ED become tied up for hours and hours on end while the healthcare system babysits these individuals. In a busy ED real-estate is a huge issue. The flow of patients coming in to an ED quite often comes to a halt when there is a surge of patients. When beds are being utilized for patients with social problems the end result is that people that are really sick do not get to the appropriate attention as quickly as they would if there was a better choice of options for these “frequent flyers”.

A forty-eight year old man comes into an ED with a complaint of chest pain. His initial evaluation shows that he is having a heart attack. At the same time a rescue brings in three intoxicated people from a car accident that are seriously injured, and someone walks into the ED lobby that is having an acute asthma attack and cannot breathe. All these patients require immediate attention. The ED is already beyond capacity, the staff does what they can both MDs and RNs. At the end of the day there is only so much that can be done for any one person. The delivery of care takes longer now; the quality of care in some cases comes into question, and the risk of medical error become very high.

A normal day in many EDs across the nation, with similar outcomes I would say. Healthcare providers prioritize during times like these. Resources are rationed in some cases. People wait and care becomes delayed while the influx of patients continues. The members of our society that make bad decisions and their consequences of such actions end them up in the ED precipitates a needless drain on the system. They are an anchor dragging the system down. The care that they require is typically costly and it is likely that much of that cost will not be paid for. When EDs are continually plagued with such scenarios everyone suffers at the hands of those who make poor choices.

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